PROJECT SUMMARY/ABSTRACT Pediatric sepsis affects over 50,000 U.S. children each year, resulting in long-term functional disability and higher risk of mortality at a cost of nearly $2 billion. Early recognition and resuscitation of pediatric sepsis can reduce mortality and improve outcomes. However, current adherence to early resuscitation guidelines remains low among pediatric sepsis and septic shock patients. Adherence to pediatric sepsis care guidelines is worse than in the adult sepsis population, especially in low-volume facilities. Compared to adults, pediatric sepsis patients may be at higher risk of disparate incidence and outcomes given sparser access to definitive pediatric hospital care. The central hypothesis of this study is that increased pediatric sepsis mortality can be partially attributed to geographic access and facility-level characteristics among patients with similar severities of illness. This study will use multi-state all-payer administrative claims data and a national readiness survey of emergency departments (EDs) to test the central hypothesis with the following aims: (1) identify facility-level characteristics associated with effective pediatric sepsis care and (2) determine the role of access to care in pediatric sepsis outcomes. The proposed work will provide a foundation of evidence to inform the development of pediatric sepsis quality improvement programs and systems for pediatric populations with decreased access to children?s hospitals. This research training project will equip Morgan Swanson (Principal Investigator) with the research experience, advanced critical thinking skills, and technical knowledge to succeed as an independent investigator. As a future physician-scientist, this project will provide Ms. Swanson with foundational skills to develop a research career focused on minimizing the burden of pediatric critical illness through improving emergency health care access and delivery.